The coronavirus vaccine in Brazil: between chaos and conflict

RIO DE JANEIRO – As countries hastened their preparations to inoculate citizens against the coronavirus, Brazil, with its world-renowned immunization program and strong drug-making capacity, should have had a significant advantage.

But political infighting, disorderly planning and a nascent anti-vaccine movement have left this South American nation, which has suffered the second-highest number of deaths from the pandemic, without a clear vaccination program. Brazilians have no idea when they will be able to get relief from a virus that has brought the public health system to its knees and crushed the economy.

“They are playing with lives,” said Denise Garrett, a Brazilian-American epidemiologist who researches public health at the Sabin Vaccine Institute, which works to expand access to vaccines. “It is almost criminal.”

Experts had clung to the hope that Brazil’s immunization capabilities would allow it to handle the end of the pandemic better than it could at the beginning.

In February, after the first case of COVID-19 was detected in the country, Brazil became the epicenter of the global health crisis. President Jair Bolsonaro dismissed the scientific evidence, defined the virus as “a miserable” cold that did not justify the shutdown of the largest economy in the region, and rebuked governors who imposed quarantine measures and business closures.

As vaccination efforts begin in the United Kingdom and the United States, giving their respective populations the opportunity to begin to imagine a life after the pandemic, Brazilian government officials are once again unprepared and engrossed. in heated disputes over vaccination policies.

Last week, the Ministry of Health presented a vaccination plan in response to an order from the Supreme Federal Court. The plan established the order in which vulnerable groups would be vaccinated, but did not detail the timeline or give a clear estimate of how many doses would be available. Previously, the ministry had said that it intended to start the vaccination campaign in March.

Days after the announcement, the ministry was still struggling to order from already overloaded vaccine providers. Government officials also faced questions about the insufficient number of syringes and vials available in Brazil to embark on the ambitious vaccination campaign, necessary to cover a country with a population of 210 million residents, where more than 180,000 have died to cause of the virus.

As if that were not enough, Anvisa, the agency responsible for health control in Brazil, has not yet approved any vaccine against COVID-19 for widespread use.

“People are going to start to panic if Brazil continues to lag behind without a plan or a clear and objective strategy,” Rodrigo Maia, president of the Brazilian Chamber of Deputies, assured on December 7 and warned that Congress would take the reins of the matter if the executive branch continued with its clumsy strategy.

The debate over vaccine access and safety has also been embroiled in a partisan dispute.

Bolsonaro has constantly vilified CoronaVac, the vaccine being developed by Chinese firm Sinovac Biotech, and rejected his Health Ministry’s plan to buy 46 million doses.

Instead, the government chose the vaccine developed by AstraZeneca and the University of Oxford, which is late in the race to receive approval from health regulators.

The president’s crusade against the Chinese vaccine created a golden opportunity, politically speaking, for João Doria, the governor of the state of São Paulo, one of his main political rivals. Doria negotiated directly with the Chinese to obtain doses of the vaccine that they are developing in association with the Butantan Institute, located in São Paulo.

Doria said state officials cannot wait for the federal government, which has gone through three health ministers during the pandemic, to organize.

“We cannot wait until March to start using a vaccine that can begin in January,” he said during an interview. “Waiting, according to the consensus in São Paulo and other states, represents a great risk for the population, since it affects fatality rates and the public health system.”

Last week, Doria promised his constituents that São Paulo intended to begin vaccinating people at the end of January, a pledge that depends on obtaining approval from federal regulators who have not yet received the final results of efficacy studies. and vaccine safety.

Brazil’s presidency repudiated Doria’s plan to start vaccinating people in January, calling it “cheap and irresponsible populism.”

The bitter feud between Doria, who is expected to run for president in 2022, and the federal government has dangerously politicized vaccination plans in Brazil. Carla Domingues, a public health researcher who led Brazil’s immunization program until last year, lamented that the COVID-19 vaccine has become a partisan affair.

“That had never happened with immunization efforts,” he said. “This is going to confuse people. It’s surreal ”.

As the number of cases soared again this month, leaving hospitals in several cities without beds for critical patients, increased pressure on the federal government from increasingly concerned regional authorities.

Last week, several governors traveled to the capital, Brasilia, to meet with the Minister of Health and demand a national immunization plan. The National Federation of Municipalities, a group that represents municipal governments, also issued a statement asking the federal government to purchase and distribute “all vaccines recognized as effective and safe against COVID-19.”

Some governors, including those of Paraná and Bahia, began trying to acquire, and eventually produce, doses of the Russian-made Sputnik V vaccine.

Carlos Lula, president of the national council of health secretaries, said the wave of state-level vaccine diplomacy and agreements are striking in a country that has spent decades building one of the most respected immunization programs in the developing world.

“It is a source of pride for the country because it has become a model for other nations,” he said. “However, suddenly we can’t handle the minimal tasks.”

Even if logistics and supply challenges are overcome, health experts say Brazil will face a new problem: a growing anti-vaccine movement that they say the president and his allies have fueled with falsehoods.

Roberto Jefferson, a former congressman who openly supports the president, said earlier this month in a message on Twitter that “the globalists were preparing a vaccine to change our DNA.”

The message, which was retweeted more than 3,000 times, claimed that Bill Gates, the American billionaire and philanthropist, was behind a “genocidal” plan to “kill millions of people and replace our DNA with the mark of the beast,” a reference to the Devil.

The growing anti-vaccine movement has led some governors, including Doria, to defend the mandatory nature of certain vaccines.

Bia Kicis, a legislator who is one of Bolsonaro’s main allies, stated that coronavirus vaccines shouldn’t be mandatory because they are “experimental” and could alter people’s DNA. Vaccine experts called those claims unfounded.

Bolsonaro has said that vaccinations should only be mandatory for dogs.

Although vaccines have never been mandatory for adults in Brazil, their efficacy and safety have never been widely questioned.

A poll published over the weekend by Datafolha, a respected Brazilian public opinion firm, revealed that 22 percent of those surveyed said they did not plan to receive the coronavirus vaccine, up from 9 percent in August.

Now the matter is in the Supreme Court, which this month will consider two cases that could give health officials the authority to make certain vaccines mandatory.

Garrett, a researcher at the Sabin Vaccine Institute, studied the rise of the anti-vaccination movement in the United States, where she worked for two decades at the Centers for Disease Control. She said she has long feared the movement would be supported in Brazil, but has been appalled at the speed and intensity of its rise during the Bolsonaro era.

“It promoted the projection of anti-vaccines in Brazil, ahead of schedule,” he said. “They are empowered and have a strong voice.”

Ernesto Londoño and Manuela Andreoni reported from Rio de Janeiro and Leticia Casado from Brasilia.

Ernesto Londoño is the head of the Brazil correspondent, based in Rio de Janeiro. He was a writer for the Editorial Board and, before joining The New York Times, was a reporter for The Washington Post. @londonoe


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